Kessler Foundation Marks National Stroke Awareness Month
WEST ORANGE, N.J.—In recognition of May as National Stroke Awareness Month, Kessler Foundation highlighted its stroke rehabilitation research and funding of employment initiatives to improve the lives of people with disabilities.
While many researchers strive to improve mobility after stroke, scientists at Kessler Foundation focus on what are known as “hidden disabilities,” which often go undiagnosed and untreated, but greatly limit independence and quality of life. Spatial neglect—a hidden disability that affects up to 70 percent of stroke survivors—is of special interest to researchers at Kessler Foundation.
“Paralysis and weakness are well recognized, while hidden disabilities are often overlooked,” said A.M. Barrett, M.D., Director of Stroke Research at Kessler Foundation. "However, recovering mobility can be slower when people have problems with communication, memory, functional vision and perception of one’s environment. Even people with mild strokes can have hidden disabilities that are highly disabling, causing problems with many functions including self care, driving, reading and navigating one’s surroundings. These disabilities prolong hospitalizations and rehabilitation and increase the risk for injury and other complications.” She is also Chief of the Neurorehabilitation Program Innovation at Kessler Institute for Rehabilitation and Professor of Physical Medicine and Rehabilitation at the University of Medicine and Dentistry of N.J.—New Jersey Medical School.
Mooyeon Oh-Park, M.D., Assistant Director of Stroke Research at Kessler Foundation, focuses her work on community education and awareness of stroke survivors.
Peii Chen, Ph.D., research scientist at the Foundation, with Dr. Barrett, founded the first Network for Spatial Neglect, which enlists the help of scientists and clinicians around the world to lessen the impact of hidden disabilities, such as spatial neglect, on recovery from stroke. Other research also analyzes mobility issues caused by stroke, factors affecting long-term outcomes and the impact on caregivers.
Research highlights include:
- Drs. Barrett and Oh-Park and Kimberly Hreha, stroke clinical research coordinator at Kessler Institute for Rehabilitation, are educating individuals, caregivers and healthcare professionals on spatial neglect. The grant, awarded by the Healthcare Foundation of New Jersey (grant #2733), funds outreach to facilities in Newark, N.J. and surrounding areas. The program’s success has led to facilities around N.J. requesting presentations. More than 260 individuals have participated in this program. Lecture attendees improved their knowledge of spatial neglect, on average, by 28%.
- Dr. Barrett and colleagues found that left-sided brain injury, including stroke, is linked with a greater risk for hospital-acquired infection. This helps healthcare professionals be proactive in preventing infection.
- Dr. Chen and Amanda Botticello, Ph.D., M.P.H., discovered that long-term caregiving may negatively impact cognition. They also found that caregivers tend to be female, older, have a lower socioeconomic status and from a minority group. Having fewer resources to begin with, the effect of caregiving may cause even greater strain. This study will aid public policy in providing necessary resources to caregivers.
- The National Institute on Disability Rehabilitation Research (NIDRR) awarded a grant to Drs. Barrett, Oh-Park and Chen to study the long-term outcomes of prism adaptation therapy to treat spatial neglect (grant #H133G120203). After two weeks of prism adaptation therapy in an inpatient setting, researchers will assess outcomes in the home and community three and six months later. Goals are to establish clinical guidelines to predict and treat spatial neglect.
- Dr. Oh-Park and colleagues investigated the low participation rate of stroke patients in hospital Patient Satisfaction Surveys (PSS). They found that impaired cognitive function was associated with low participation in PSS among individuals who were discharged home. No association with cognitive function was found among patients discharged to a non-home environment. The development of strategies to capture the experience of this population is needed for an accurate survey.
- Dr. Oh-Park collaborated on a study that the severity of acute spatial neglect predicts a smaller ‘life-space’—the extent of a person’s movement from his or her bedroom during routine daily activities—among right brain stroke survivors. Further investigation is needed to find the underlying mechanisms of the link between spatial neglect and reduced life-space.
- Foundation Research Scientist Karen Nolan, Ph.D., and Neil Jasey, M.D., of Kessler Institute for Rehabilitation, are part of a multi-centered study, funded by Innovative Neurotronics, Inc. to test the WalkAide device versus the standard Ankle-Foot Orthosis (AFO) to treat foot drop after stroke.Foot drop is the inability to raise the forefoot, causing a tendency to drag the foot while walking. The AFO is an open plastic assistive brace that is worn inside a flat shore to help maintain the foot in position. The WalkAide is a device about the size of a pager that straps to the leg just below the knee. It applies electrical stimulation to trigger the foot to lift and relax during walking and can be worn with or without shoes. If the WalkAide proves effective, it makes a case for insurance coverage.
- The Kessler Foundation Neglect Assessment Process is showing positive results for reliably identifying and treating spatial neglect. “Our goal is to develop guidelines for assigning prism treatment, based on behavior or brain imaging during the first weeks after stroke,” said Dr. Chen.
Spatial neglect research at Kessler Foundation is showing positive results for individuals recovering from stroke, including Robert Vroeginday, 52, from New Milford, N.J. After a massive stroke nearly four years ago, his brain was unable to process images from the center to the left of his field of vision. This greatly limited his independence as he could no longer safely perform daily activities, such as driving. During inpatient rehabilitation, he participated in the Foundation’s prism goggle study. After two months in the study, Vroeginday regained his license and now drives and lives independently. Drs. Barrett, Oh-Park and Chen, as well as Hreha, are beginning a study where caregivers can administer prism goggle adaptation therapy in the home.
In addition to conducting rehabilitation research, Kessler Foundation also distributes grant funding to organizations that create or expand employment opportunities for people with disabilities. “Some of our special initiatives focus on job skills training and support needs of individuals who have disabilities caused by stroke,” said to Elaine Katz, VP of Grants and Special Initiatives. Stroke-specific grants include:
- The County of Bergen, in N.J., to defray the costs of providing speakers and therapists presenting education programs to the Post Stroke and Disabled Support Group Program. The County also received a grant to provide an opportunity for socialization, recreation, rehabilitative instruction and restorative exercises to stroke survivors.
- The Adler Aphasia Center, in Maywood, N.J., to expand the ‘Something Special’ gift shop at the Adler Aphasia Center which promotes vocational and business training for people with aphasia to help them regain self-sufficiency. Aphasia impairs the brain’s ability to understand and process language, which affects the person’s ability to speak and read. Intelligence, however, is not affected. At the gift shop, a woman with aphasia teaches the art of jewelry making to her peers. The socialization and confidence helped her improve her communication and quality of life.
Recent Publications and Presentations:
- Shah, P., Spaldo, N., Barrett, A. M., & Chen, P. (2013). Assessment and functional impact of allocentric neglect: A reminder from a case study. The Clinical Neuropsychologist. doi: dx.doi.org/10.1080/13854046.2013.783120
- Barrett, A. M., Goedert, K. M., & Basso, J. C. (2012). Prism adaptation for spatial neglect after stroke: translational practice gaps. Nature Reviews Neurology, 8(10), 567-577. doi: 10.1038/nrneurol.2012.170
- Chen, P., & Goedert, K. M. (2012). Clock drawing in spatial neglect: A comprehensive analysis of clock perimeter, placement, and accuracy. Journal of Neuropsychology, 6, 270-289. doi: 10.1111/j.1748-6653.2012.02028.x
- Chen, P., Goedert, K. M., Shah, P., Foundas, A. L., & Barrett, A. M. (2012). Integrity of medial temporal structures may predict better improvement of spatial neglect with prism adaptation treatment. Brain Imaging and Behavior. doi: 10.1007/s11682-012-9200-5
- Chen, P., Hreha, K., Fortis, P., Goedert, K. M., & Barrett, A. M. (2012). Functional assessment of spatial neglect: A review of the Catherine Bergego Scale and an introduction of the Kessler Foundation Neglect Assessment Process. Topics in Stroke Rehabilitation, 19(5), 423-435. doi: 10.1310/tsr1905-423
- Chen, P., McKenna, C., Kutlik, A. M., & Frisina, P. G. (2012). Interdisciplinary communication in inpatient rehabilitation facility: Evidence of under-documentation of spatial neglect after stroke. Disability and Rehabilitation. doi: 10.3109/09638288.2012.717585
- Das, A., & Chen, P. (2012). The eyes in the scanner: Latent conjugate eye deviation. Neurology India, 60(3), 343-344. doi: 10.4103/0028-3886.98536
- Goedert, K., Chen, P., Botticello, A., Masmela, J. R., Adler, U., & Barrett, A. M. (2012). Psychometric evaluation of neglect assessment reveals motor-exploratory predictor of functional disability in acute-stage spatial neglect. Archives of Physical Medicine and Rehabilitation, 93, 137-142. doi: 10.1016/j.apmr.2011.06.036
- Hung, C., Barrett, A.M., & Oh-Park, M. (2013, February). The severity of spatial neglect predicts life-space among right hemipsheric stroke survivors. Presented at the Association of Academic Physiatrist, New Orleans, LA. http://www.physiatry.org/?page=2013_Sun
About Kessler Foundation
Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit KesslerFoundation.org.